It is an exceptionally difficult time to find a job in America, as employers work through a hiring hangover from the pandemic and hesitate to invest in new staff with policy changes coming fast and furious from Washington.
But the picture is even worse without one sector: health care.
The industry, and related professions in the social assistance category, added 693,000 positions last year. Without it, the economy would have lost 512,000 jobs, as business and professional services, retail, the federal government and manufacturing all contracted.
Health care’s insatiable growth is good news for people who make it into the profession, offering mobility and options for advancement. It’s why nurses in New York City won pay increases and job protections last month after a weekslong strike that had forced hospitals to spend heavily on traveling staff, and why health care positions offer signing bonuses uncommon for most professions.
But it also highlights the sluggishness in the rest of the labor market, where hiring has been glacial. As the unemployment rate has drifted upward, most job postings have attracted qualified candidates quickly — except for medical positions, which are taking longer to fill, said Raj Namboothiry, senior vice president for the United States at Manpower, a staffing company.
“Health care has constantly shown gains when the rest of the sectors are on pause,” Mr. Namboothiry said. “This has become America’s most reliable job engine. Health care is keeping the lights on.”
Some of the growth is catch-up hiring for a sector that took longer than most to recover from the pandemic after frontline workers burned out and left the field. But the quicker pace could be sustained as the youngest baby boomers retire and need more care, from hospitals to home health aides.
“Health care stands out right now because it is doing its natural thing,” said Kosali Simon, a health economist at Indiana University-Bloomington. “What’s not happening is that other sectors are not doing the same. Health care is not as discretionary — it has to grow.”
An Ever-Stronger Anchor
The growth of the health care industry is not new. Driven by changes in consumer spending and expanding access to insurance as well as the aging population, the health and social assistance sector went from 8.3 percent of total employment in 1990 to nearly 15 percent today, compared with about 8 percent for manufacturing. Health care’s dominance only grows during recessions because people still have to go to the doctor even if they decide to put off buying a new car.
The sector’s expansion has been good for places that have become medical hubs, especially outside major metropolitan areas that have lost large industrial employers.
Take Montour County, Pa., which has the highest density of health care jobs in the country. More than half of its approximately 18,000 workers are employed in the industry, largely at the Danville headquarters of Geisinger Health, a hospital system that has been snapping up smaller clinics around the state. The company is in the middle of an $880 million construction project to add more operating rooms and private beds.
Jennifer Wakeman, the economic development director for the five-county region including Danville, said the industry had expanded fairly consistently in a place without many other large economic drivers.
“If you think about economic development statistics 101, it’s job creation and capital investment. They do both of those things,” Ms. Wakeman said. “It’s a huge benefit to the community to have that kind of player literally in our backyard.”
Or look at Morgantown, W.Va., where losses of steel manufacturing and coal mining jobs have been more than offset by the growth of West Virginia University’s medical school, which started its own insurance plan in 2021 and employs more than 26,000 people. Telehealth services that exploded during the pandemic mean that clinicians can serve more people across the rural, sicker-than-average state, which expanded its Medicaid program in 2014.
The institution is strong enough that when Mylan Pharmaceuticals, a generic drug manufacturer, shut down a factory with 1,500 workers in 2021, W.V.U. Medicine took it over and turned it into a health sciences business incubator.
“To most communities, losing a big employer like that would have had a devastating impact,” said Russ Rogerson, president of the Morgantown Area Partnership. “But it really didn’t have a major negative impact in Morgantown and Monongalia County because the growth of our health care industry absorbed it.”
It’s not just small towns that benefit. Las Vegas, recognizing the cyclical nature of its hospitality industry, committed during the 2009 recession to invest in health care, including a new medical school. Since 2015, employment in the sector has grown 56 percent across the metropolitan area, compared with 23 percent overall. A children’s hospital is slated to break ground this year.
Shani Coleman, director of community and economic development for Clark County, which includes Las Vegas, sees the city’s casinos and hospitals as complementary. Patients can come from out of town to have a good time before getting their medical procedure. And although entertainment industry employment just barely recovered after the pandemic, its workers transition naturally to roles at the bedside.
“As a community, our hospitality industry does customer service really well,” Ms. Coleman said. “When you take that and are able to marry it with health care, it creates an opportunity where you have a high level of care.”
Help Always Wanted
It’s not clear that the supply of workers will keep pace with the ever-growing need for care. Although artificial intelligence may cut down administrative positions in billing and marketing, bedside jobs are not being replaced anytime soon.
Richard Merchant is the chief executive of the Health Workforce Collaborative of New York, which coordinates employers and training programs to match people with skills in demand, especially as the existing medical corps nears retirement.
“It is true that the health care industry is going strong,” Mr. Merchant said. “It would have to be going a lot stronger and the distribution would have to be much better than it is to actually keep up with the vacancies that are increasing.”
Filling those vacancies has gotten harder over the past year, Mr. Merchant said, since 35 percent of medical workers in New York State are immigrants. The Trump administration has squeezed avenues for workers to come in from overseas, including doctors on H-1B visas, who are particularly important for rural clinics, as well as the millions of people with temporary protected status, such as Haitians, who have staffed nursing homes and rehabilitation facilities.
Their absence could be felt quickly: A 25 percent increase in immigration flows would save 5,000 lives every year in the United States, a paper published recently by the National Bureau of Economic Research found.
Other changes by the Trump administration might also constrict the pipeline of new medical workers, such as its plan to cap student loans for graduate nursing degrees at $100,000.
Olivia Jackson left her career as a cook a few years ago, looking for better pay and more regular hours. After being laid off from a job at a Washington State agency last summer, knowing the high demand for nurses, she enrolled at a community college to take the prerequisites for nursing school. She is worried about being able to borrow enough to afford it.
“I want to be a nurse practitioner, but I’m not certain I’ll be able to get the funding I need to get there,” Ms. Jackson said. “I’m currently on unemployment. I don’t have any money to live off of, or pay tuition.”
Nursing offers the highest earnings potential without going to medical school, but there are other options — and high demand for workers with more specific skills, like running an EKG machine, sterilizing surgical equipment and analyzing lab samples. Cengage, a company that provides short-term online training modules, said sales of medical courses were growing 20 to 40 percent annually.
One of the highest-demand jobs requires little education but pays about as much as fast food work: home health aides. Medicaid and Medicare pay most of their salaries, but rates are low, and could get lower after President Trump signed legislation last year that restricted federal health spending.
“If Medicaid is only going to pay $16 an hour, and it’s below what the market should be paying, you’re going to run into some of these issues,” said Gopi Shah Goda, director of the Retirement Security Project at the Brookings Institution. “It’s just another way of saying that at the prevailing wage, there’s just not an ample supply of workers.”
A Leaky Bucket
The other challenge is ensuring that once people get the education they need, they stick around to do the job.
The extreme strain of the pandemic sent hundreds of thousands of medical workers to the exits in 2020 and 2021. Even after the crisis passed, conditions like understaffing and violence against care providers pushed many out of the profession. According to the job review website Glassdoor, health care workers judge their employers more harshly than workers in other sectors. Olga Yakusheva, an economist at the Johns Hopkins School of Nursing, has estimated that one in three licensed registered nurses is no longer working in the profession.
“We just spent all of this time educating the nurses, and they can’t stay and work,” Ms. Yakusheva said. “What we have is not a shortage of nurses, but there is a shortage of job openings that nurses are willing to fill.”
Lloyd Stanley went to nursing school in his late 30s, after several years as an emergency medical technician. He spent a few years in urgent care centers and skilled nursing facilities, and then began to work for nurse staffing agencies to maintain more flexibility as he cared for his own mother, who has dementia. Through the pandemic, he said, he saw management make financially driven decisions that compromised patient care, like not having adequate supplies or staff.
Mr. Stanley doesn’t plan to leave nursing. Though gig work can be frustrating, he loves the basic tasks of helping people. But he does see why people become disillusioned and quit.
“You are working in facilities that are inherently frustrating,” he said. “Nurses want to take care of people. I feel like that nature is taken advantage of a little bit. It can be pretty demoralizing.”
Lydia DePillis reports on the American economy for The Times. She has been a journalist since 2009, and can be reached at [email protected].
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